Laminaria Insertion

Aka: Laminaria Insertion, Laminaria, Laminaria digitata, Dilateria, Lamicel, Dilapan

1. Indications
   1. Cervical dilation prior to Dilation and Curettage
2. Advantages
   1. Safe and effective
   2. Less cervical trauma and pain than with dilator
3. Preparations
   1. Laminaria digitata
      1. Seaweed stem of 2-3 mm width
      2. String attached to end for removal
      3. Swells on contact with water
         1. May reach up to 5x its original width in 12 hours
   2. Synthetic alternatives to Laminaria
      1. Dilateria
      2. Lamicel
      3. Dilapan
4. Procedure
   1. Prepare Cervix
      1. Expose Cervix with medium Graves speculum
      2. Use antiseptic over Cervix and posterior fornix
      3. Apply single toothed tenaculum to anterior Cervix lip
   2. Insert uterine sound just past cervical os
      1. Opens cervical os to allow for insertion of Laminaria
      2. Helps determine cervical orientation
      3. Do not fully insert
         1. Not necessary to determine uterine depth
   3. Insert Laminaria
      1. Hold tenaculum to steady Cervix
      2. Hold Laminaria with ring forceps and insert into os
      3. Allow Laminaria tip to pivot to find cervical canal
      4. Fully insert Laminaria into Cervix
      5. Consider placing second Laminaria next to first
         1. Indicated if gestational age >11 weeks
      6. Remove tenaculum
         1. Apply sponge against Laminaria to prevent removal
5. Follow-up
   1. Leave Laminaria in overnight
   2. Remove Laminaria at time of Dilation and Curettage